By Megan Rauscher

NEW YORK (Reuters Health) - Results of a brain imaging study suggest that the brain may be affected very early in the course of lupus, even before the disease is diagnosed.

Lupus, technically known as systemic lupus erythematosus or SLE, is a chronic "autoimmune" disease in which the immune system can confuse healthy and foreign tissues and sometimes attacks both. The condition can vary widely in severity, manifesting as skin rash and arthritis or leading to damage to the kidneys, heart, lungs and brain to varying degrees. There is no cure.

Among a group of 97 patients with newly diagnosed SLE, 25 percent had brain abnormalities on magnetic resonance imaging (MRI), researchers found. All of the patients were within 9 months of being diagnosed with SLE.

These observations indicate that "lupus affects the brain even in newly diagnosed patients," study chief Dr. Michelle Petri of Johns Hopkins University, Baltimore, Maryland, told Reuters Health. "We were shocked actually; we thought it took more time for lupus to involve the brain," she acknowledged.

Brain atrophy (wasting), the most common abnormality seen on MRI, was present in 18 percent of patients with newly detected SLE, and focal brain lesions were present in 8 percent of study subjects.

Anxiety disorder was more common in patients who had signs of brain wasting. "Our study suggests that there may be a relationship between brain volume loss and anxiety," the investigators note.

Given the high frequency of neurological and psychiatric SLE manifestations and structural brain abnormalities, more research is urgently needed to determine the underlying cause of these changes, "in order to develop rational treatment options," the team concludes.

SOURCE: Journal of Rheumatology, December 2008.

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